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City of Rosevielle <br />Finance Department� License Division <br />E660 Civic Center Driveg RoseviHe, MN 55113 <br />(651) 490-2212 <br />Amusement Device License Application <br />Business Name <br />Business Address <br />Business Phone <br />Person to Contact in Regard to Business License <br />ry ro <br />F <br />IOUs � m,,, �� mu Uri, i <br />��� .�� � � xr �;;, ,.,,..�, � y�y��� . %i����11fi��.�. /������, ri,. xli�l�� /� %�i / %((ka .1112 0� <br />I hereby apply for the following license(s) for the terra of one year, beginning Jul 1 .2-0613 . <br />3 03 � 0 Y , in the City of Roseville � � y s and ending .Tune <br />} County of Ramsey, State of Minnesota. <br />License Re uired Fee Ouanti <br />Total <br />Amusement Device $15.00 <br />(per machine) <br />The undersigned applicant snakes this application pursuant to all the lags of the Mate of - <br />the Council of the i of Roseville Minnesota and re�ulation as <br />may from time o time prese 'h , ' eluding Minnesota Statue #176.182. <br />S ignat ue <br />Date <br />If completed license should he mailed somewhere other than the business address <br />please advise. <br />For office use Daly: <br />Receipt # <br />